| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,599 |
1,492 |
$52K |
| D0120 |
Periodic oral evaluation - established patient |
2,523 |
2,361 |
$39K |
| D1206 |
Topical application of fluoride varnish |
1,429 |
1,315 |
$27K |
| D1120 |
Prophylaxis - child |
975 |
905 |
$21K |
| D0274 |
Bitewings - four radiographic images |
832 |
772 |
$19K |
| D0330 |
Panoramic radiographic image |
95 |
82 |
$3K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
62 |
38 |
$3K |
| D0210 |
Intraoral - complete series of radiographic images |
72 |
64 |
$3K |
| D0272 |
Bitewings - two radiographic images |
137 |
119 |
$2K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
40 |
36 |
$1K |
| D0140 |
Limited oral evaluation - problem focused |
12 |
12 |
$415.28 |
| D1208 |
Topical application of fluoride, excluding varnish |
378 |
372 |
$205.90 |
| D1999 |
|
34 |
32 |
$0.00 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
12 |
12 |
$0.00 |